If you missed the ACA open enrollment deadline or a qualifying life event just happened in your household, a Special Enrollment Period (SEP) may give you the access you need. In 2026, most qualifying life events trigger a 60-day window to enroll in a Marketplace health plan outside the standard November-to-December open enrollment period. This guide covers every qualifying event, the 2026 income limits that determine your subsidy, and exact steps to apply through healthcare.gov.
What Is an ACA Special Enrollment Period?
An ACA Special Enrollment Period is a limited window outside of open enrollment when you can pick up health insurance coverage through the Marketplace. Most SEPs run for 60 days from the date of the qualifying event. Losing Medicaid or CHIP coverage extends the window to 90 days in most states.
Coverage typically begins on the first day of the month after you enroll. The exception is newborns and adopted children, who receive retroactive coverage starting on their date of birth or placement.
To use a SEP, you generally must have had minimum essential coverage before the qualifying event, or be gaining coverage for the first time through a specific event such as marriage or birth. The Marketplace will ask you to confirm your qualifying event and may ask for documentation.
As of 2026, the year-round low-income SEP that allowed households below 150% of the Federal Poverty Level to enroll at any time has been eliminated. That change, which took effect for the 2026 plan year, means income alone is no longer a standalone qualifying trigger. You now need a qualifying life event, regardless of income. Households in this income range should check whether they qualify for Medicaid, which has no enrollment deadline, through the CoveredUSA screener.
2026 ACA SEP Qualifying Life Events
According to healthcare.gov, the following events qualify you for a Special Enrollment Period in 2026.
Loss of Health Coverage
Losing your health insurance involuntarily is the most common SEP trigger. This includes:
- Losing a job-based health plan (layoff, resignation, or employer stops offering coverage)
- Aging off a parent's health plan at age 26
- Loss of Medicaid or CHIP eligibility
- COBRA coverage expiring
- Losing coverage through a spouse's employer plan after divorce or death
- An employer plan becoming unaffordable (defined in 2026 as costing more than 9.96% of household income for employee-only coverage)
You do not qualify for a loss-of-coverage SEP if you voluntarily dropped your plan or failed to pay premiums.
Changes in Household or Family Status
- Getting married (60 days from the date of marriage)
- Having a baby (retroactive to date of birth)
- Adopting a child or placing a child in foster care
- Getting divorced or legally separated, especially if you lose coverage as a result
- Death of a household member that causes you to lose coverage
Moving to a New Coverage Area
If you move to a location served by different Marketplace health plans, you qualify for a 60-day SEP. This includes moving to a new ZIP code, county, or state. You must show you had coverage in your previous location (or had Medicaid or Medicare) unless you are moving from abroad, from a shelter, or from incarceration.
Other Qualifying Events
- Gaining U.S. citizenship or lawful immigrant status
- Leaving incarceration
- Gaining status as an American Indian or Alaska Native tribal member (you may also enroll monthly if you fall in this category)
- An employer starting or changing an HRA (ICHRA or QSEHRA) arrangement
- Natural disaster or other exceptional circumstance as declared by the Marketplace
- Changes in income or household composition that affect your subsidy eligibility in ways that create a new qualifying event
2026 ACA Income Limits and Subsidy Eligibility
Your income relative to the Federal Poverty Level (FPL) determines whether you qualify for premium tax credits when you enroll through a SEP. As of 2026, the subsidy cliff has returned. Households earning above 400% FPL no longer qualify for premium tax credits, as the enhanced subsidies from the American Rescue Plan expired at the end of 2025.
The table below uses the 2026 Federal Poverty Guidelines published by HHS ASPE for the 48 contiguous states and Washington D.C.
2026 ACA Subsidy Income Thresholds by Household Size
| Household Size | 100% FPL (2026) | 138% FPL (Medicaid threshold) | 400% FPL (subsidy cap) |
|---|
| 1 person | $15,960 | $22,025 | $63,840 |
| 2 people | $21,640 | $29,863 | $86,560 |
| 3 people | $27,320 | $37,702 | $109,280 |
| 4 people | $33,000 | $45,540 | $132,000 |
| 5 people | $38,680 | $53,378 | $154,720 |
| 6 people | $44,360 | $61,217 | $177,440 |
| 7 people | $50,040 | $69,055 | $200,160 |
| 8 people | $55,720 | $76,894 | $222,880 |
| Each additional | +$5,680 | +$7,838 | +$22,720 |
Alaska and Hawaii use higher FPL figures. If you live in either state, your income thresholds for subsidy eligibility will be higher than those in the table above.
What subsidy level can you expect?
- 100% to 150% FPL: Premium tax credits may reduce your monthly plan cost to $0 or near $0
- 150% to 250% FPL: Premium tax credits plus cost-sharing reductions that lower your deductible and out-of-pocket maximum (must choose a Silver plan to receive CSR)
- 250% to 400% FPL: Premium tax credits on a sliding scale with no cost-sharing reductions
- Above 400% FPL: No premium tax credits; you pay full unsubsidized premiums
If your income is at or below 138% FPL and your state expanded Medicaid, you likely qualify for Medicaid rather than a Marketplace plan. Medicaid has no enrollment deadline. Check your eligibility at CoveredUSA to see which program fits your situation. You can also review the full ACA income limits breakdown.
How to Apply for an ACA SEP in 2026
Enrollment window: 60 days from the date of your qualifying life event (90 days for loss of Medicaid or CHIP)
Step 1: Confirm your qualifying event date
Write down the exact date your qualifying event occurred. This is the start of your 60-day window. If you are unsure whether your situation qualifies, call the Marketplace helpline at 1-800-318-2596 before your window closes.
Step 2: Gather your documents
You will likely need to submit proof of your qualifying event within 30 days of selecting a plan. Collect the following in advance:
- Proof of qualifying event (see checklist below)
- Social Security numbers for everyone in your household applying for coverage
- Dates of birth for all household members
- Most recent federal tax return or an estimate of your 2026 income
- Employer and income information for all household members
- Current health insurance information (if any remains)
Documents by qualifying event type:
- Job-based coverage loss: employer letter confirming end of coverage, COBRA election notice, or explanation of benefits
- Aging off parent's plan: letter from insurer or employer stating coverage end date
- Birth or adoption: birth certificate, adoption decree, or placement agreement
- Marriage: marriage certificate
- Divorce with loss of coverage: divorce decree and letter showing loss of coverage
- Moving: lease agreement, utility bill, or other proof of new address; proof of prior coverage
- Loss of Medicaid: state Medicaid agency termination letter
Step 3: Apply through the correct Marketplace
Go to healthcare.gov if your state uses the federal exchange. If you live in one of the roughly 20 states that runs its own exchange (California, New York, Washington, Colorado, Connecticut, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, or Washington D.C.), go directly to that state's exchange website.
Log in or create an account. If you applied before, your information may pre-fill.
Step 4: Report your qualifying event
When completing your application, select your qualifying event type and enter the date it occurred. The Marketplace will verify whether your event creates an active SEP window and, if so, what coverage start date applies to you.
Step 5: Compare and select a plan
Plans are organized by metal tier: Bronze, Silver, Gold, and Platinum. If your income falls between 100% and 250% FPL, select a Silver plan to access cost-sharing reductions. Choosing Bronze while CSR-eligible means you give up that benefit.
After selecting a plan, complete enrollment and pay your first premium. Coverage does not begin until payment is received.
Step 6: Upload verification documents
Submit proof of your qualifying event within 30 days of selecting a plan. Failure to provide documentation can result in loss of coverage or retroactive cancellation.
Step 7: Confirm your coverage
You will receive a confirmation from the exchange and a welcome packet from your insurer. Your insurance card typically arrives within two to three weeks of your first payment. Keep all documentation in case of future coverage disputes.
Common reasons SEP applications are denied:
- Event occurred more than 60 days before application (window expired)
- Coverage loss was voluntary (you chose to drop coverage)
- Moving occurred without prior coverage in the previous location (required in most cases)
- Income falls below 100% FPL in a state that did not expand Medicaid (Medicaid gap)
- Documentation submitted after the 30-day deadline
Important 2026 SEP Changes to Know
Low-income SEP eliminated. Starting with the 2026 plan year, the SEP that allowed households below 150% FPL to enroll year-round is no longer available through HealthCare.gov. This affects roughly 4 million people who used that pathway. If you are in this income range, check Medicaid eligibility first via Medicaid.gov or CoveredUSA.
Enhanced subsidy cliff returned. The American Rescue Plan's expanded premium tax credits expired at the end of 2025. As of 2026, no subsidies are available above 400% FPL. This affects about 2 million enrollees who were previously receiving assistance at higher incomes, according to KFF.
Stronger verification requirements. CMS finalized additional SEP eligibility verification requirements. Be prepared to submit documentation promptly. Delays or missing documents can result in coverage gaps.
State-Run Exchange SEP Differences
If you live in a state that runs its own marketplace, SEP rules may differ slightly from HealthCare.gov. Some state exchanges offer additional qualifying events not available federally. For example, several states recognize pregnancy as a standalone SEP trigger. Check your state exchange website for state-specific rules.
| State | Exchange | Notable SEP Differences |
|---|
| California | Covered California | Pregnancy is a qualifying event |
| Massachusetts | Health Connector | Pregnancy, domestic partnership recognized |
| New York | NY State of Health | Pregnancy, DACA status qualify |
| Washington | Washington Healthplanfinder | Pregnancy is a qualifying event |
| Colorado | Connect for Health Colorado | Broad exceptional circumstances SEP |
| Kentucky | kynect | Pregnancy qualifies |
For most other states using HealthCare.gov, pregnancy is not a standalone qualifying event (though giving birth is), and the standard 60-day rule applies uniformly.
If You Missed Open Enrollment and Have No Qualifying Event
Without a SEP, your options for 2026 coverage outside open enrollment are limited:
- Medicaid or CHIP: Year-round enrollment with no deadline. If your income falls below about 138% FPL (in expansion states), you qualify at any time. Use the CoveredUSA screener to check.
- Short-term health plans: These do not meet ACA standards, are not required to cover pre-existing conditions, and do not qualify as minimum essential coverage. They may be useful as a temporary bridge but carry significant coverage gaps.
- COBRA: If you recently left a job, COBRA lets you keep your employer plan for up to 18 months at full cost. This is often expensive but provides uninterrupted coverage with no new qualifying event required.
The next standard open enrollment for 2027 coverage opens November 1, 2026. If none of the above applies, marking that date on your calendar is your best path to coverage.
Check your eligibility now at CoveredUSA, it takes 2 minutes. Start the screener.
Frequently Asked Questions
Who qualifies for a Special Enrollment Period in 2026?
Anyone who has experienced a qualifying life event in 2026 qualifies for an ACA Special Enrollment Period. Common qualifying events include losing job-based health coverage, getting married, having a baby, adopting a child, moving to a new coverage area, turning 26 and aging off a parent's plan, and losing Medicaid or CHIP eligibility. Each event opens a 60-day enrollment window from the date the event occurred.
How long does a Special Enrollment Period last in 2026?
Most SEPs last 60 days from the date of the qualifying event. Losing Medicaid or CHIP coverage extends your window to 90 days in most states. After the window closes, you cannot enroll until the next open enrollment period in November unless another qualifying event occurs.
What happened to the low-income SEP in 2026?
The year-round special enrollment period for households below 150% of the Federal Poverty Level was eliminated starting with the 2026 plan year. If you are in this income range, you now need a qualifying life event to trigger a SEP. The better option for most people at this income level is Medicaid, which has year-round enrollment in states that expanded coverage.
Can I get ACA subsidies during a Special Enrollment Period?
Yes. If you enroll through a SEP and your income is between 100% and 400% FPL, you qualify for premium tax credits on the same sliding scale as open enrollment enrollees. As of 2026, no subsidies are available above 400% FPL because the enhanced American Rescue Plan credits expired at the end of 2025.
What documents do I need to prove a qualifying life event?
Documents depend on the qualifying event. Coverage loss requires an employer termination letter or COBRA election notice. Marriage requires a marriage certificate. Birth or adoption requires a birth certificate or adoption decree. Moving requires proof of new address (lease or utility bill) plus proof of prior coverage. You typically have 30 days from plan selection to submit documents through the Marketplace.
What if my application is denied because my SEP window expired?
If you did not enroll within 60 days of your qualifying event, you generally cannot use that event to open a new window. Your options include applying for Medicaid if your income qualifies (year-round enrollment), waiting for the next open enrollment starting November 1, 2026, or checking with your state's insurance commissioner whether any state-specific SEPs apply to your situation.
Does moving to a new state trigger a Special Enrollment Period?
Yes. Moving to a new ZIP code, county, or state that has different available health plans qualifies you for a 60-day SEP. You generally must have had coverage in your previous location (or Medicaid, Medicare, or other qualifying coverage) to use this SEP. Keep documentation of your prior address and prior coverage when you apply.
Where do I apply for an ACA plan during a Special Enrollment Period?
Go to healthcare.gov if your state uses the federal exchange. If your state runs its own exchange (such as Covered California, Washington Healthplanfinder, or kynect in Kentucky), go directly to that state's website. A licensed insurance agent or certified navigator can also help you apply at no cost.
